Applying a Human-Centric Design Approach to Organisational Systems
GSA x NHS is a collaborative project between third year Product Design students at the Glasgow School of Art and Crosshouse Hospital. As an Open Source project, our aim for the project was to develop a set of tools that requires the application of staff knowledge in order to identify challenges within the area of patient flow.
In that sense, we worked in groups but collaborated all our findings so that our information was as accurate as possible. Within our studio environment we worked as a class with a flat hierarchy in order to share the workload and produce our deliverables. During this project we worked with many hospital staff and the patients seeking care in order to get a range of perspectives. These included nurses, charge nurses, doctors, junior doctors, patients, bed managers, discharge co-ordinator, porters and domestics. The information we gathered from everyone we observed and interviewed contributed to the entire design process.
During the initial research process, we were divided in six groups that looked at different areas in the hospital. During that time, we made two visits to the hospital, where we were given free access to any area or to engage with any member of staff. Simultaneously, we conducted desk research and analysis in our studio.
For our first trip to the hospital we started by attending the morning huddle to see how information is shared after a shift change. We then separated into groups and each covered a different part of the hospital. The areas we went to during this visit were: A&E, cardiology, pharmacy, respiratory, gastroenterology and discharge. We gathered basic information about each area so that as a class, we could start to understand the patient flow process.
After grouping the information, we came up with new titles for the areas we wanted to focus on during our second visit to the hospital and the rest of the project: A&E, Discharge, Patient Role, Pharmacy, Communication and Trust. We returned to the hospital to gather more in-depth information and ask specific questions for each of these areas. However, our main aim for our second visit was to get more of an idea about staff and patient feeling. This meant we conducted longer interviews to find out personal stories and the reasons behind them.
At the hospital we used various methods to gather information. We choose to take a very personal approach therefore, spending little time looking at big statistics and more time on personal stories and observations.
One of these methods was observation. We let staff go about their day as usual and we simply shadowed without interfering whist taking notes and sketching.
We conducted informal interviews with members of staff. We also spoke with patients so we could find out how they felt their time in hospital had been. This method gave us personal perspectives and also allowed us to compare different parts of the hospital.
Afterwards, each group began to build user journeys specific to their areas of the hospital. This would give us a better overview of the hospital and also lead us to ask better and more informed questions on our second visit.
After the second visit, we gathered all the information and mapped in order to define user journey time-lines. We realised each one was unique to the individual but we could group information to particular circumstances to understand the routes people usually take in the hospital and who is involved at each stage. These journeys could then be analysed to identify where patient flow lost efficiency.
The information acquired was vast and very complex, which made us identify the need of valuable communication and interaction systems.
With that in mind, our proposal was to provide the staff with the necessary design tools to make them identify their own issues and work on them. We agreed on creating a game that would allow people to understand different roles and the implications that come with them. For that, they would resource to insight cards, with a persona and its problem, and build scenarios based on it.
After mapping the information acquired, we started identifying opportunities. For that, each team developed five different insights that were presented to the whole class. In order to validate their accuracy, a smaller group went back to the hospital and presented them to different members of staff.
In order to demonstrate our insights in the clearest way possible, we chose to design a set a cards. They represented the main issues that each group identified during their research in the different areas of the Hospital. They represented not only problems, but also design opportunities to improve the patient flow in the hospital. Each contained a scenario of an issue and the respective persona's that interact in that specific situation.
Triangle of Communication
The process of the role-play came in the form of a booklet so it could be easy to follow and understand. Our hope was that the essence of the role-play could be used in the wards to quickly put staff in other colleagues' shoes to help them understanding of the many issues in different roles.
The tool is made of a drawing of a triangle that represent three elements that ensure good communication: Understanding, Knowledge and Trust. Each vertex represents the maximum score of each element. Users can then evaluate each of the key aspects of communication after and give them a score from 1 (bad) to 10 (good) based on the following questions:
Knowledge: How accurate was the information?
Understanding: How clearly was the information transmitted?
Trust: How well did people rely on the information that was being passed?
Once the users have given scores to each element, a new triangle is formed by joining the dots, which reveals the areas where users can work on solutions.
Final Product & Presentation
The final product consists of a set of tools that should be used amongst hospital staff. The insights we gathered are only a starting point to help people afterwards identify their own issues and work through them with the help of the kit. We also delivered a book where our project and processes used were explained so its continuity could be ensured.
The presentation was ran by five members of the class. As I was the first to speak I had to ensure an appropriate tone and to break the ice, as it would determine the audience’s engagement throughout the rest of it.
The hospital was very happy with the outcome and moments later we were requested to participate in a Learning-Disabilities conference that was being organised the following week.
In this conference there were only four of us, the main presenters. As the subject was specific to Learning-Disabilities we adjusted our presentation, as rather than presenting our findings, we introduced the guests to our method and how this could be used in their context, as in any large organisation. Once again the reception was very positive, which resulted in the creation of workshops (one of which already took place) in order to put the staff the work with the tools themselves.
After the project presentation, five of us have already participated in a Learning-Disabilities Conference and facilitated a workshop with the Hospital and the Kilmarnock community. In April 2016 we facilitated a NHS Hackathon alongside Snook. Later on in the same year, the project was presented as part of a Health Conference in Florida, US.